Early mobility and crawling: beliefs and practices of Pediatric Physical Therapists in the United States.

Kari S Kretch Stacey C Dusing, Regina T Harbourne, Lin-Ya Hsu, Barbara A Sargent, Sandra L Willett

• PMID: 38127897
• PMCID: PMC10873088
• DOI: 10.1097/PEP.0000000000001063

Abstract

Purpose: To characterize beliefs of pediatric physical therapists (PTs) in the United States regarding the role of crawling in infant development and clinical practice.

Methods: Pediatric PTs reported their beliefs about early mobility and crawling, clinical approaches related to early mobility and crawling, and agreement with the removal of crawling from the Centers for Disease Control and Prevention (CDC)'s updated developmental milestone checklists in an online survey. Analyses examined associations between information sources and beliefs, between beliefs and clinical approaches, and between beliefs and CDC update opinions.

Results: Most participants believed that crawling was important (92%) and linked to a variety of positive developmental outcomes (71%-99%) and disagreed with its removal from the CDC checklists (79%). Beliefs were linked with clinical approaches focused on promoting crawling and discouraging other forms of mobility.

Conclusions: Further research is needed to determine whether pediatric PTs' beliefs and clinical practices are supported by evidence.

AACPDM special: Effects of Power Training combined with interval treadmill training on walking capacity versus performance in real world settings in youth with cerebral palsy.

This paper is a contender for the AACPDM’s highest abstract honour - the Gayle G Arnold Award - to be presented at The American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Conference - the 79th Annual Meeting!

“Celebrating Resilience” October 15-18, 2025, to be held in New Orleans, LA.

Where’s the Evidence? Challenging Therapists to Stop Legitimizing Dynamic Movement Intervention and Cuevas Medek Exercises.

Paleg, Ginny PT, MPT, DScPT; Pool, Dayna PT, PhD; Hidalgo-Robles, Álvaro PT, MSc; Frumberg, David MD; Livingstone, Roslyn OT, MSc(RS); Damiano, Diane PT, PhD

Open Access!
https://journals.lww.com/pedpt/fulltext/9900/where_s_the_evidence__challenging_therapists_to.204.aspx

Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical models rather than contemporary motor learning principles.

A review of the literature reveals that CME, despite 5 decades of use, is supported only by a few case reports and 2 small, biased comparative studies. DMI, introduced in 2021, has no published empirical evidence beyond a single conference abstract. Thus, both interventions remain at Sackett Level 5—no evidence.

The ethical implications are substantial. Families often pay thousands for intensive, noncovered therapies that may displace meaningful participation in education and social life.

Therapists have a professional responsibility to avoid legitimizing unproven practices and to prioritize interventions supported by robust evidence. Pediatric rehabilitation should shift toward child-led, functional, and task-specific approaches grounded in modern motor learning science, with professional bodies and insurers withholding endorsement of non evidence-based methods.

Karina A Zapata, Rosa H Cooksey, Daralyn K Fulton, Hayley B Shelton, Chan-Hee Jo, Richard C Adams

Affiliations Expand

• PMID: 40556501
• DOI: 10.1111/dmcn.16397

Abstract

Aim: To determine the baseline pediatric reference values of the 6-minute walk test (6MWT) distance (6MWD) across spina bifida functional lesion levels, the associations between the 6MWD and the distances of the 1-minute and 2-minute walk tests, and assess the impact of social determinants on the 6MWD.

Method: This prospective cohort study collected the 6MWD of 145 ambulatory children (72 male, 73 female; mean age = 11 years 2 months [range: 6 years 0 months-17 years 11 months]) with mid-lumbar-level (n = 59), low-lumbar-level (n = 28), and sacral-level (n = 58) myelomeningocele at a pediatric hospital. Proxies of social determinants included insurance type and Area Deprivation Index (ADI). Pairwise comparisons evaluated the 6MWD according to lesion level and myelomeningocele functional classification (MMFC) group.

Results: The mean 6MWD was shorter for myelomeningocele at the mid-lumbar versus low-lumbar versus sacral lesion levels (p < 0.001), and MMFC2 versus MMFC3 versus MMFC4 (p < 0.001). The mean 1-minute and 2-minute walking distances were strongly associated with the 6MWD. Children with public insurance and a high ADI walked significantly fewer meters than children with private insurance (p = 0.023) and a low ADI (p = 0.048).

Interpretation: Children with higher anatomical functional lesion levels walked shorter distances than those with lower levels and according to MMFC group. The 1-minute and 2-minute walk tests are adequate substitutes for the 6MWT. Lower socioeconomic status affecting decreased walking capacity merits interventions to maximize opportunities for activity.

Trajectories of Fidgety Movements in Infants with and without medical complexity.

This paper is a finalist for AACPDM’s highest honour - the Gayle G Arnold award, chosen and highlighted by the scientific review committee for it’s high quality.

We look ahead at The American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Conference - the 79th Annual Meeting!

“Celebrating Resilience” October 15-18, 2025, to be held in New Orleans, LA.

Continuing our AACPDM 2025 Preview series!

Effect of high-frequency, low magnitude vibration on physical activity and physical function in children with cerebral palsy: a randomised controlled trial

This paper is a contender for the AACPDM’s highest abstract honour - the Gayle G Arnold Award!

There is still time to register for the conference in beautiful New Orleans - Visit https://www.aacpdm.org/events/2025 for all the details!

The effect of immediate weightbearing after planovalgus foot reconstruction in ambulatory children with cerebral palsy

Background and Objective(s)

Planovalgus (PV) is a common foot deformity in children with cerebral palsy (CP). Orthopedic surgery is widely established as an effective treatment for deformity correction though there is clinical variation in post-op therapy protocols. Immediate weightbearing (WB) after PV foot correction could accelerate recovery but concern for post-op complications causes reluctance. The aim of this study was to determine the prevalence of complications after PV foot surgery in children with early WB vs. non-WB (NWB).

Study Participants & Setting

135 ambulatory children with CP (GMFCS I (12%), II (58%), III (30%)) met inclusion criteria and were included from a children’s hospital setting and assessed in the gait laboratory.

Materials/Methods

This IRB-approved retrospective cohort study included ambulatory children (GMFCS I-III) with CP and PV foot deformity who underwent reconstructive surgery and pre (within 18 months) and post-op (1-3 years) gait analyses. Complications were defined in three timeframes: (1) short-term, within 6 months of surgery, by radiograph review for nonunion, hardware failure, or infection requiring return to surgery, (2) mid-term, at 1-3 years, by pedobarographic assessment, and (3) long-term, > 3 years, by recurrence requiring surgical revision. Fisher exact tests compared the prevalence of complications between immediate WB and NWB groups. Regression analysis evaluated the relationship between complications and child, surgical, and post-operative factors.

Results

140 surgical events were completed on 224 feet at age 12.7 ± 2.8 years. Following surgery, 84% of children followed an immediate WB protocol, and 16% were NWB for the first six weeks. The prevalence of short-term complications between the WB and NWB groups was no different (nonunion/hardware failure/infection, WB 3%/1%/0%; NWB, 0%/3%/0%; p>0.9). There were no between group differences in mid-term correction status (under- corrected/corrected/over-corrected, WB 31%/45%/24%; NWB, 32%/54%/14%; p>0.9). The prevalence of long-term recurrence necessitating surgery was not significantly different (WB/NWB, 3%/11%; 8.5±2.8 years post-op; p>0.9). Regression analysis demonstrated WB status was not a significant predictor of correction status or long-term recurrence requiring revision (p>0.05).

Conclusions/Significance

Complication rates were very low after planovalgus foot correction surgery in ambulatory children with CP. There were no significant differences in complications, clinical outcomes, or need for surgical revision between groups who followed immediate WB vs. NWB post-op protocols. Immediate WB after PV foot correction surgery presented no increased risks compared to NWB and should be encouraged in children with CP. Early WB, standing, and walking may prevent disuse muscle weakness and promote faster recovery of gross motor mobility, enhancing patient care. Future studies should examine the impact of early WB on recovery time and long-term functional outcomes.

Elizabeth Maus, Ben Reader, Jill C Heathcock

Abstract

Aims: To quantify the number and types of mobility devices used by children with cerebral palsy (CP) and explore the relationships between Gross Motor Functional Classification System (GMFCS) level, age, insurance, income, and number and types of devices.

Method: This was a secondary analysis of a cohort from a larger randomized controlled trial. Data from 89 children with CP (56.2% male and 43.8% female; mean = 4 years 11 months; SD = 2 years 0 months; range 2 years 0 months-8 years 10 months) were collected from electronic medical records, parent-completed medical history questionnaires, and the Hollingshead Four-Factor Index. The analysis included quasi-Poisson and logistical regressions.

Results: Most children had Medicaid insurance (83.2%). All income and GMFCS levels were represented. The most common mobility devices were lower-extremity orthoses (75.3%). The number of devices used increased by 8.2% for each 1-year increase in age. Children classified in GMFCS level V used 5.1, 2.9, and 1.6 times more mobility devices than children classified in GMFCS levels I, II, and III respectively. GMFCS level also predicted the use of wheelchairs, bath chairs, and standers. Income and insurance were not significant.

Interpretation: Children used more devices as age and GMFCS level increased. Device access is an important public health initiative.